The effect of human immunodeficiency virus on hepatitis B virus serologic status in co-infected adults

Abstract

Background: Factors associated with serologic hepatitis B virus (HBV) outcomes in HIV-infected individuals remain incompletely understood, yet such knowledge may lead to improvements in the prevention and treatment of chronic HBV infection.

Methods and findings: HBV-HIV co-infected cohort participants were retrospectively analyzed. HBV serologic outcomes were classified as chronic, resolved, and isolated-HBcAb. Chronic HBV (CHBV) was defined as the presence of HBsAg on two or more occasions at least six months apart. Risk factors for HBV serologic outcome were assessed using logistic regression. Of 2037 participants with HBV infection, 281 (14%) had CHBV. Overall the proportions of HBV infections classified as CHBV were 11%, 16%, and 19% for CD4 cell count strata of > or =500, 200-499, and <200, respectively (p<0.0001). Risk of CHBV was increased for those with HBV infection occurring after HIV diagnosis (OR 2.62; 95% CI 1.78-3.85). This included the subset with CD4 count > or =500 cells/microL where 21% of those with HBV after HIV diagnosis had CHBV compared with 9% for all other cases of HBV infection in this stratum (p = 0.0004). Prior receipt of HAART was associated with improved HBV serologic outcome overall (p = 0.012), and specifically among those with HBV after HIV (p = 0.002). In those with HBV after HIV, HAART was associated with reduced risk of CHBV overall (OR 0.18; 95% CI 0.04-0.79); including reduced risk in the subsets with CD4 > or =350 cells/microL (p<0.001) and CD4 > or =500 cells/microL (p = 0.01) where no cases of CHBV were seen in those with a recent history of HAART use.

Conclusions: Clinical indicators of immunologic status in HIV-infected individuals, such as CD4 cell count, are associated with HBV serologic outcome. These data suggest that immunologic preservation through the increased use of HAART to improve functional anti-HBV immunity, whether by improved access to care or earlier initiation of therapy, would likely improve HBV infection outcomes in HIV-infected individuals.

Figure 1. HBV infection outcome by CD4 cell count strata.

(CHBV, chronic hepatitis B virus infection; IcHBV, Isolated HBcAb hepatitis B virus infection; RHBV, resolved hepatitis B virus infection).

Figure 2. HBV infection outcome by timing of HBV infection relative to HIV diagnosis.

(Panel A, Overall; Panel B, by CD4 cell count strata) (CHBV, chronic hepatitis B virus infection; IcHBV, Isolated HBcAb hepatitis B virus infection; RHBV, resolved hepatitis B virus infection).

Figure 3. HBV infection outcome by ART use prior to HBV diagnosis.

(Panel A, Overall; Panel B, by CD4 cell count strata; Panel C, by timing of HBV infection relative to HIV diagnosis). (CHBV, chronic hepatitis B virus infection; IcHBV, Isolated HBcAb hepatitis B virus infection; RHBV, resolved hepatitis B virus infection).